I 111th CONGRESS 1st Session H. R. 3472 IN THE HOUSE OF REPRESENTATIVES July 31, 2009 Mrs. Dahlkemper introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means and Education and Labor, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To provide for health insurance coverage premium discounts for healthy behavior and improvements toward healthy behavior.

1.

Premium discounts for healthy living

(a)

In general

Notwithstanding any other provision of law, for plan years beginning on or after January 1, 2010, a group health plan, and a health insurance issuer offering group health insurance coverage in the group market or health insurance coverage in the individual market, shall provide premium discounts for healthy behavior and improvements toward healthy behavior as determined under this section. (b)

Determination of premium discounts

(1)

In general

Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services, acting through the Director of the Centers for Disease Control and Prevention, shall conclude a rulemaking procedure to determine the appropriate premium discount applicable to each healthy behavior and each improvement toward healthy behavior. Such discounts shall be consistent with the regulations applicable to wellness programs issued under the Health Insurance Portability and Accountability Act of 1996. (2)

Limitation

Such discounts shall not, in the aggregate, exceed 20 percent with respect to any individual. (c)

Healthy behavior

For purposes of this section, the following are healthy behaviors: (1)Not smoking. (2)Low blood pressure (but within the normal range). (3)Body mass index (BMI) in the normal range. (4)Low low-density lipoprotein (LDL) levels. (5)High high-density lipoprotein (HDL) levels. (6)Appropriate hemoglobin AIC levels. (d)

Improvements towards healthy behavior

For purposes of this section, the following are improvements towards healthy behavior: (1)Quitting smoking. (2)Reducing blood pressure, but not below the normal range. (3)Lowering body mass index (BMI), but not below the normal range. (4)Lowering low-density lipoprotein (LDL) levels. (5)Increasing high-density lipoprotein (HDL) levels. (6)Lowering hemoglobin AIC levels, but not below the normal range. (e)

Certification

In order to be taken into account under this section, any healthy behavior or improvement towards healthy behavior must be supported by medical test result information which is certified by a licensed physician, and the individual to whom it relates, as being complete, accurate and current. In the case of any knowingly false certification under this subsection, the Secretary of Health and Human Services shall impose a civil monetary penalty not in excess of $1,000. (f)

Application to ERISA, PHSA, and IRC

The provisions of this section shall apply with respect to a group health plan as if included under title XXVII of the Public Health Service Act, under title VII of the Employee Retirement Income Security Act of 1974, and under subchapter B of chapter 100 of the Internal Revenue Code of 1986, and shall apply with respect to health insurance coverage offered in the individual market as if included under title XXVII of the Public Health Service Act.